Total diet replacement shows promise for difficult-to-treat asthma

A low-calorie total diet replacement program (Counterweight-Plus) is safe and improves asthma control and quality of life in patients with difficult-to-treat asthma and obesity, according to 16-week data from a recent study.

The study randomized 35 adults with difficult-to-treat asthma and body mass index of ≥30 kg/m² to undergo Counterweight-Plus weight management program (CWP) or receive usual care.

Delivered by dietitians, CWP training ran in three phases: total diet replacement (low-energy liquid diet consisting of 825–853 kcal/day) for up to 12 weeks, food reintroduction (reducing formula diet and stepwise reintroduction of calorie-controlled made) between 13 and 18 weeks, and weight loss maintenance between 19 and 52 weeks. Meanwhile, usual care involved standard asthma care, such as the continuation of previously initiated asthma medication or modification of treatment based on need.

Of the participants, 33 attended 16-week follow-up (17 on CWP and 16 on usual care). The mean asthma control questionnaire (ACQ6) score at baseline was 2.8. At week 16, the CWP group achieved greater weight loss than the usual care group (mean difference, –12.1 kg, 95 percent confidence interval [CI], –16.9 to –7.4; p<0.001).

The primary outcome of ACQ6 decreased more in the CWP than the usual care group (mean difference, –0.69, 95 percent CI, –1.37 to –0.01; p=0.048). Furthermore, a larger proportion of participants in the CWP group achieved minimal clinically important difference in ACQ6 (53 percent vs 19 percent; p=0.041; number needed to treat, 3, 95 percent CI, 1.5–26.9).

The secondary outcome of asthma quality of life questionnaire score at week 16 was significantly higher in the CWP than the usual care group (mean difference, 0.76, 95 percent CI, 0.18–1.34; p=0.013).